NPIMap

Organization Active NPI

Neighborhood Health Association of Toledo, Inc

Doing business as Navarre Park Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Toledo, OH
National Provider Identifier
1912330689
Registry record updated Apr 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEIGHBORHOOD HEALTH ASSOCIATION OF TOLEDO, INC
Doing business as
Navarre Park Family Health Center
Practice address
1020 Varland Ave
Toledo, OH 43605-3245
Phone
(419) 696-1515
Fax
(419) 696-1529
NPI assigned
Aug 16, 2013
Last updated
Apr 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sandra D Miller-Corbett
Title
Ceo
Phone
(419) 720-7883

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1020 Varland Ave
Toledo, OH 43605-3245

Mailing address

313 Jefferson Ave
Toledo, OH 43604-1004
Phone (419) 720-7883

Other identifiers 1

IdentifierTypeStateIssuer
0119309MedicaidOH

Other names 1

  • Navarre Park Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140228001224 OH Part B Supplier - Clinic/Group Practice 5698686665 Receives reassigned benefits from 19 practitioners
7 other NPIs on this enrollment
Practice locations: Toledo, OH; Holland, OH
O20150128002143 OH Part A Provider - Federally Qualified Health Center (FQHC) 5698686665 Practice locations: Toledo, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912330689. Details of each certification follow.

Federally qualified health center certification: CCN 361061

Legal name
NEIGHBORHOOD HEALTH ASSOCIATION OF TOLEDO, INC
Doing business as
NAVARRE PARK FAMILY CARE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 13, 2015
Last certification
Jan 13, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 28, 2014 in OH
Enrollment address
1020 Varland Ave
Toledo, OH 43605-3245

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Neighborhood Health Association16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Talmadge Thomas Individual Corporate OfficerBoard Chair Sep 27, 2019
Jose Balderas Individual Corporate DirectorBoard Member Sep 27, 2019
Shane Douglas Individual Corporate OfficerCoo Nov 1, 2019
W-2 Managing EmployeeCoo Nov 1, 2019
Angela Jordan Individual Corporate OfficerBoard Member Sep 27, 2019
Christopher Kiehl Individual Corporate OfficerBoard Member Sep 27, 2018
Doni Miller Individual Corporate OfficerCeo Mar 1, 1993
W-2 Managing EmployeeCeo Mar 1, 1993

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Nexus Health CareToledo, OH, CCN 361105 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459814400000",
    "number": "1912330689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 JEFFERSON AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041004",
            "telephone_number": "419-720-7883",
            "fax_number": "419-720-7895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 VARLAND AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436053245",
            "telephone_number": "419-696-1515",
            "fax_number": "419-696-1529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD HEALTH ASSOCIATION OF TOLEDO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-16",
        "last_updated": "2016-04-05",
        "status": "A",
        "authorized_official_last_name": "MILLER-CORBETT",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-720-7883"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0119309",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Navarre Park Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.